HEALTH CARE IN FRANCE - American School of Paris

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HEALTH CARE IN FRANCE - American School of Paris

American School of Paris

Welcome Committee

HEALTH CARE IN FRANCE

PRESENTED AND PREPARED BY

ANNA GIULIONE, RN

ASP Welcome Committee Health Care in France

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Health Care In France

Welcome

Introduction

Dealing with emergencies

Out-patient services

Health care insurance

Dental care

Sources

ASP Welcome Committee Health Care in France

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Healthcare in France


Introduction

WHO ranked the French healthcare service

FIRST out of 191 countries

Offers wide choice of general practioners

and healthcare specialists

Universal healthcare for all residents of

France

Offers public and private healthcare

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Dealing With Emergencies

SAMU (emergency services/ambulance)

Tel. 15

Sapeurs Pompiers (Fire Department ) Tel.18

Police Secours (Police Department) Tel. 17

Poison Control Center: 01 40 05 48 48

Emergency Hotline at the American

Hospital of Paris: 01 47 47 70 15

Post these numbers by the phone.

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Dealing With Emergencies

When telephoning for an emergency service, have the

following information ready:

Your name and address, including floor (etage) and

entrance code if necessary; preferably in FRENCH

Patient’s name and age

Nature of illness or injury (what happened and when)

Present condition (patient is unconscious, pt is vomiting,

pt is bleeding, pt is confused…..)

Any other pertinent information (patient is diabetic, pt has

a heart condition, takes blood thinner medication….)

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Dealing With Emergencies




Everyone in your family must learn how to say their name and address

in FRENCH.

Write out personal information phonetically and leave it by the

phone:

• Je m’appelle (JEM-APPEL) Anna Giulione (JEW-LEE-O-NEE)

• J’habite (JAB-IT) a 38 (TRENTE-HUIT) rue Amedee Dufaure (AM-A-DAY DUE-

FOUR)

• Rueil Malmaison (RUE-ALE MAL-MAE-ZON)

• Mon numero de telephone est 01-47-49-69-51 (ZERO UN-QU(K)ARANT SET-

QU(K)ARANT NUF- SINQU(K)ANT ET(EH) UN)

Use whatever phonics works best with your family

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Dealing With Emergencies

If you do not speak French and do not have anyone else

who can make the call, simply speak slowly and clearly in

English.

Do not yell. Remain CALM.

There is usually someone (the doctor) who speaks English

at SAMU center (Tel. 15) and at the fire department (Tel.18).

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DEALING WITH EMERGENCIES

Emergency Hotline at the American Hospital of Paris:

01 47 47 70 15

You will usually find an English speaking person to help

you.

You can call and ask for advice or request that a staff

member call an ambulance or another service for you.

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LIFE THREATENING EMERGENCIES

Any situation that impedes the AIRWAY, BREATHING or

CIRCULATION and any CHANGE IN MENTAL STATUS (LEVEL OF

CONSCIOUSNESS) is considered life-threatening.

• For example: squeezing chest pain, choking, severe

asthma attack, severe burn, severe blood loss or

hemorrhaging, drowning, child/infant with severe

diarrhea…..

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LIFE THREATENING EMERGENCIES

WHO TO CALL IN CASE OF AN EMERGENCY (URGENCE)!!

DIAL 18

This is the number of the FIRE DEPARTMENT /PARAMEDICS

(SAPEUR POMPIER). The pompier are not only fireman, they

are also professionally trained PARAMEDICS.

» Forget 911

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NON-LIFE THREATENING

EMERGENCIES

FOR LESS SEVERE EMERGENCIES -NON LIFE-THREATENING

• DIAL 15 -SAMU

This is the national emergency organization in France. It

has 24 hour service, with MD’s in attendance.

The policy in France is NOT to rush the patient to the

hospital but rather rush the hospital to the patient. Known

as mini-ER’s on wheels.

Expect to be asked numerous questions by SAMU in order

to determine which service to send to your home.

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NON-LIFE-THREATENING

EMERGENCIES

If you are not sure whether your situation is lifethreatening

or non-life-threatening CALL 18 (Sapeurs

Pompiers /Fire Department).

Explain the situation and let the Pompiers/Paramedics

decide.

If you call SAMU (15) they will help you as well.

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THE EMERGENCY ROOM

Emergency medicine is not a recognized specialty in

France. The ER’s are manned by qualified doctors with

various specialties who take turns staffing the service.

Not every hospital is equipped to handle all emergencies.

It is best to check the services available at the hospital

closest to your home.

Follow up with your personal physician. You may ask for a

copy of your records before leaving the ER to bring to your

doctor.

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POISON CONTROL

For Poison Control you can call the Poison Control Center

(Centre Anti-Poison) at the Hopital Fernand-Widal.

Tel- 01 40 05 48 48

There is no guarantee of speaking with someone in

English. In this case you may call SAMU centre 15, a

physician on duty can provide advice and assistance as

necessary. You can also call the American Hospital of

Paris Hotline: 01 47 47 70 15

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DESCRIPTIONS OF INDIVIDUAL

EMERGENCY SERVICES

SAMU (Service d’Aide Medicale d’Urgence)- Tel. 15

• (Ambulance, medical doctors, use for serious BUT not

life-threatening emergencies)

A specialized public emergency service that works in

close alliance with other emergency services and with

the emergency and intensive care units of the public

hospitals.

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DESCRIPTIONS OF INDIVIDUAL

EMERGENCY SERVICES

SAMU continued

Its ambulances are manned by teams of trained

professional medical personnel and equipped with

miniature emergency rooms containing materials

necessary to treat emergency situations at the scene,

including cardiac and respiratory arrest.

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DESCRIPTIONS OF INDIVIDUAL

EMERGENCY SERVICES

SAMU continued

SAMU is organized geographically into departments with

a central telephone number for each area in France. Calls

are answered under the direction of a physician on duty

who decides, based on careful questioning of the caller,

how to handle the call.

Each department has a pediatric team trained to treat

severely ill or injured children

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DESCRIPTIONS OF INDIVIDUAL

EMERGENCY SERVICES


SAMU continued

SAMU will almost always have someone available who can

speak or at least understand English - usually the

physician. If it is a life-threatening situation, the

dispatcher will connect you to an emergency physician

who will determine the appropriate level of care needed

and can talk you through any emergency procedures that

need to be accomplished while waiting for the emergency

team to arrive on the scene.*

*Health Network International and WICE. Health Care in Paris, p.9

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DESCRIPTIONS OF INDIVIDUAL

EMERGENCY SERVICES


SAMU continued

Each SAMU center has a list of bed availability and

locations of specialty teams in all public hospitals. This

list is updated three times a day.

If patients need to be hospitalized they are usually taken

to a public hospital, but can be taken to a private hospital

upon request. (Je prefer un hopital prive)

If bed is available patient is transported directly to room

or intensive care unit, bypassing the emergency

department.

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DESCRIPTIONS OF INDIVIDUAL

EMERGENCY SERVICES

THE FIRE DEPARTMENT (SAPEURS POMPIERS - TEL. 18)

• (Firefighters, paramedics, ambulance, CPR, first aid for life

threatening emergencies)

has an emergency ambulance service equipped to treat

emergencies

In Paris and other large cities, firemen are professionals

who are trained in CPR and basic life support, but this may

not be true in smaller towns where firemen are

volunteers.

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DESCRIPTIONS OF INDIVIDUAL

EMERGENCY SERVICES


THE FIRE DEPARTMENT (SAPEURS POMPIERS) continued:

tries to keep its response times to less than 5 minutes.

After triaging and analyzing your situation they may send

one of it’s own ambulances or it may alert SAMU, another

emergency service, or an on-call physician.

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DESCRIPTIONS OF INDIVIDUAL

EMERGENCY SERVICES

THE POLICE DEPARTMENT (POLICE SECOURS - TEL. 17)

Responsible for public safety.

Many levels of “police”

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DESCRIPTIONS OF INDIVIDUAL

EMERGENCY SERVICES

ON CALL MEDICAL SERVICES [House Calls]

Many doctors and other paramedical services in France

make house call

When you are ill and unable to reach your own doctor, or if

your doctor does not make house calls, you can phone

one of the on-call physician services that exist in France

and arrange for a home visit. (Your Mairie usually has a

list of doctors who make housecalls)

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DESCRIPTIONS OF INDIVIDUAL

EMERGENCY SERVICES


ON CALL MEDICAL SERVICES continued:

Doctors making home visits do not normally dispense

medications, but will often administer injections on the

spot if needed.

• Prescriptions for medications can be filled out at your local

“pharmacie” or “pharmacie de garde” after hours.

• The pharmacies in your neighborhood take turns for dispensing

medications after hours in case of emergencies. ( The rotation is

posted on the doors of the pharmacies. Your local police

department also has the list.

• Laboratory tests or x-rays can be performed at local “laboratoire”

and “radiologie” centers.

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DESCRIPTIONS OF INDIVIDUAL

EMERGENCY SERVICES

SOS MEDECINS TEL.

01. 47 .07. 77 .77

L’ASSOCIATION POUR LES URGENCES MEDICALES DE PARIS TEL.

01.48.28.40.04

These doctors are trained in emergency care

usually speak English

Always request a letter of care from the doctor to bring to

your own physician for follow up.

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OUT-PATIENT SERVICES

One of the characteristics of the current French Health Care System is

freedom of choice.

Patients are completely free to choose a GP (generaliste)

Since January 2006 you must register with a “Treating Doctor”

medecine traitant to qualify for reimbursement with the Securite

Sociale (French social security) this does not necessarily apply to

expats with private insurance.

Most specialists require a referral from a GP

You do not need a referral to see an ophthalmologist , gynecologist ,

dermatologist, or if you have a known illness and are already followed

by a specialist elsewhere.

You do not need a referral if you are already followed by a specialist

in another country.

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OUT-PATIENT SERVICES

PERSONAL PHYSICIANS

Ask your friends, neighbors, embassies, pharmacists to

refer or recommend a doctor.


Most French doctors understand English but may have

some difficulty speaking English

Your Mairie (townhall) usually has a list of doctors that

speak foreign languages


Refer to handout of English speaking doctors prepared by

the ASP welcome committee or the ASP website or the ASP

nurse .

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OUT-PATIENT SERVICES

THE DOCTOR’S OFFICE

Usually a house or an apartment. Rarely in a medical

building

Many French doctors work alone (no receptionist, no

nurse)

You will find instructions posted at the door to enter and

wait in the waiting room for your turn. The doctor will

greet you when he sees you.

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OUT-PATIENT SERVICES

THE DOCTOR’S OFFICE Continued

It is not customary to have a nurse present during an

examination, including gynecological exams.

You may be asked to disrobe for an examination in the

presence of your doctor.

It is unusual to be offered a gown as a cover-up, so you

should expect to be nude or semi-nude during the visit.

If you find this uncomfortable bring a long shirt with you

for your examination.

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OUT-PATIENT SERVICES

THE DOCTOR’S OFFICE Continued

French doctors are not accustomed to being asked many

questions, nor do they give detailed information about

your condition and /or treatment. Ask as many questions

as you like.

They do not stock medications in their offices.

If you need an injection, you will be given a prescription to

take to the pharmacy, after which you may return to the

doctor’s office or may visit a private nurse to have the

injection. (The pharmacist can recommend a nurse in

your neighborhood)

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OUT-PATIENT SERVICES

THE DOCTOR’S OFFICE Continued

You may notice that you are often prescribed more

medications than you are used to.

You may ask the doctor if they are all necessary and/or

ask for essential medications only.

Fees are payable at the end of the visit (cash, cheque and

sometimes carte bleu)

The doctor will fill out a billing form and it is your

responsibility to claim for reimbursement from Social

Security or your private insurance plan (mutuelle).

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SUPPORT SERVICES

PHARMACIES

Recognized by a green cross

Pharmacists in France play a bigger role and are more

active in suggesting medications and/or treatments to

people.

Valuable source of health information.

There are many medications in France for which a

prescription is not necessary.

You must ask a pharmacist for any medication, including

all over-the-counter, non prescription medication such as

“Tylenol” (Paracetamol ASP Welcome or Committee Doliprane).

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SUPPORT SYSTEMS







PHARMACIES Continued

Long term prescriptions are filled out for ONE to THREE month(s) at a

time. You MUST KEEP your prescription and bring it back to the

pharmacy for refills. The prescription is only good for 6 months.

Afterwards you must return to your doctor for another prescription.

Very uncommon for doctors to call in a prescription.

Medications are dispensed in prepackaged boxes. The amount of pills

to take per day will not be indicated on the box. Make sure to keep the

prescription for directions or write it out on the box. The medication is

not counted out. It is normal to have extra pills. You can return the

extra medication to your pharmacy.

You can ask the pharmacist to prepare pediatric medications.

You can also get medication for your PETS from most pharmacies.

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SUPPORT SYSTEMS

PHARMACIES continued

When filling a prescription a vignette or barcode is

removed from the packaging and placed on the billing

form (feuille de soin)

Fill out name, date of birth, and any other information your

insurance company asks for.

Send completed forms to your insurance company for

reimbursement. Don’s forget to sign your forms.

Pharmacists are aware of the health professionals in your

neighborhood and can assist you with your needs.

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SUPPORT SYSTEMS

DIAGNOSTIC PROCEDURES (X-RAY AND LABORATORY TESTS)

The doctor will usually write out a requisition for specific

blood/urine test and/or x-ray. Blood and urine tests are

NOT done in the Doctor’s office.

The patient takes the requisition to the proper lab or x-ray

facility. You will find “Laboratoires” and “Centre de

Radiologie” in your communities. Appointments are

necessary for lab work. Keep in mind most blood tests

require fasting for at least 8-12 hours before the test. Ask

your doctor or the lab for instructions.

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SUPPORT SYSTEMS

DIAGNOSTIC PRCEDURES Continued

It is best to make an appointment for x-rays.

Once the tests are completed you may be asked to return

to pick up the results and to take them to your doctor.

Some facilities fax or mail the results to your doctor.

Payment for lab work or x-rays are expected once tests

are completed. Most facilities accept cash, check or

“Carte Bleu”.

You will be given 2 copies of your results. One is for the

doctor and one is for your own file. You are responsible for

your own medical file.

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HEALTH INSURANCE

The French Healthcare system is funded by the working

population.

Universal Healthcare for all residents of France.

Social protection and health insurance system comes

under Social Security (Securite Sociale).

The primary health insurance (Carte Vitale) reimburses a

portion or all of the medical costs of dependants. The

remaining amount is covered by personal private

insurance. (Insurance Companies (Mutuelle) vary

according to employer)

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HEALTH INSURANCE

Doctors are either conventionné (fees set by the State

Health System), or non-conventionné (fees set by the

doctor)

97% of doctors are conventionne, however may add an

additional fee depending on their specialty

For most expatriates private insurance reimburses health

costs. Inform yourselves on the procedure to follow for

reimbrusements.

Fees (Tarifs) are usually posted in the doctoer’s office.

Coverage or reimbursement depends on your primary

health insurance fund from Social Security and/or private

insurance.

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HEALTH INSURANCE

REIMBURSEMENT PROCEDURES

The doctor fills out and signs part of the billing form

(feuille de soin) and gives this to the patient, who then

fills out and signs his or her own section.

Most health facilities have started implementing

electronic billing to remove the paperwork. It is

important, in this case, to ask for a receipt (reçu) for your

insurance company for reimbursement.

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HEALTH INSURANCE

REIMBURSEMENT continued

For reimbursement, fill in the section that pertains to the

patient and send the doctor’s billing form (with doctor’s

prescription for treatment and/or diagnostic tests) to the

appropriate primary insurance company.

Don’t forget to sign and date your form.

Reimbursement can by made by bank transfer (direct

deposit)

[Refer to handout]

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HOSPITALS

2 Types of hospitals in France: Public and Private

They are equipped with the best specialty teams and

equipment and can handle a range of emergencies.

Know what specialties are offered at the hospital in your

community.

Private “cliniques” are used primarily for obstetrics and

elective surgeries. They tend to offer the patient more

amenities than larger public hospitals.

Cliniques do not usually have an Emergency Department.

“Centre Medicales are outpatient diagnostic clinics

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HOSPITALS

Private hospitals tend to have a shorter

waiting period for elective surgeries

Smaller size

Modern facilities

Mainly have private rooms or semi-private

rooms

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HOSPITALS






AP-HP (Assistance Publique des Hôpitaux de Paris)

Europe’s first hospital complex, Assistance Publique-Hôpitaux de Paris (AP-HP) is a

public health organization that reports to the City of Paris. AP-HP is also the Ile-de-

France Region’s medical schools hospital network that includes patients’ care,

teaching programs and research.

As a treatment organization, AP-HP counts 39 hospital facilities––17 of them within the

French capital––with a total of 24,977 beds and 750 clinics and medical technical

centers that can treat 1,246 persons every day. A total of 90,658 people practice 150

different healthcare trades in its facilities. AP-HP’s provides an essential contribution

to basic and clinical research in human health.

Private hospitals

Paris tallies a great number of private hospitals that house treatment facilities as well

as research labs.

(Hospitals in France website)

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AMERICAN HOSPITAL OF PARIS







Private hospital.

You will find English speaking doctors and some nurses.

Limited number of American doctor’s and other staff members. Mostly

French doctors who have studied abroad and speak English.

Diagnostic results and health record may be written in French.

Provides emergency services for adults.

Pediatric clinic on site however for emergencies children should be

taken to other hospitals that specialize in Pediatric emergencies,

such as Hopital Necker-Enfants Malades in the 15th arrondissement.

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VACCINATIONS

Recommendations for immunizations are very similar in

France and Other Countries. The schedule for the

immunizations vary from country to country. (Refer to

handout by Dr. Nancy Salzman)

The BCG immunization for tuberculosis is compulsory in

France for children attending a creche or daycare and

must be administered by the latest at the age of 6

In most countries the BCG vaccine is not compulsory and

rarely given

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VACCINATIONS

At the American School of Paris it is common for the

students to have an annual TB skin test to prove they have

not had exposure to tuberculosis.

For children who have not had the BCG immunization the

TUBERTEST or PPD or Mantoux test is performed on a yearly

basis and compulsory for attending ASP.

Doctor’s usually perform this test in their office.

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VACCINATIONS

You must bring the medication to the doctor’s office. The

tuberculine test is injected subcutaneously in the

forearm. After 72 hours you must return to the doctor to

have the test read. In other words, to examine if you have

had a reaction to the tuberculine.

You can buy the TUBERTEST at the pharmacy before going

to your doctor. However, you will need a prescription from

the doctor for reimbursement.

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DENTAL CARE

DENTAL EMERGENCIES

S.O.S. DENTISTE 01.43.37.51.00

AMERICAN HOSPITAL DENTAL CLINIC 01.46.41.25.25

Dentists do not make house calls

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DENTAL CARE

Dentistry is curative with less emphasis on preventative.

English speaking dentists are available.

Ask friends, doctors, neighbors, embassies, pharmacists

for recommendations.

Only dentists are allowed by law to work on your teeth, so

you will not find dental hygienists in France.

Pediatric dentists are available. Pedodontics

(pedodentistes) are specially trained dentists who treat

children. Most pedodentists have studied and trained in

North America, therefore will most likely speak English.

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DENTAL CARE





The water in France is not fluoridated.

Fluoride assists in preventing tooth decay by increasing the

resistance of tooth enamel to cavities. The administration of fluoride

is most effective during infancy and childhood when teeth are

forming.

Should not exceed 1mg of Fluoride a day.

In France, fluoride supplements (ZYMOFLUOR) are given to children up

to the age of 15 to ensure that all permanent teeth receive the benefit

of fluoride. It is preferable to see a dentist for proper fluoride

treatment.

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DENTAL CARE

Too much fluoride can result in mottling/discoloration of

the teeth as well as soft enamel causing chipping.

Table salt, bottled water, toothpaste…contain fluoride.

Orthodontics is a recognized specialty. Most

Orthodontists have studied abroad in the UK, USA or

Canada, and speak English.

Orthodontics is covered partially by health insurance for

children up to 16 years old and the remainder by private

insurance. Check with your insurance for coverage.

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SOURCES

Bloom where you’re planted: How to live in France: 30th

anniversary edition, 2000-2001

Guide for Canadian Citizens in France: Canadian Embassy

Consular Services, May 2000.

Health Care in Paris: A joint venture by Health Network

International and WICE, Third edition, 1998.

Nancy Salzman, MD

Meri-Kathryn Peed, RN

GOOGLE- Healthcare in France

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